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12665 POST THIS CARD NEAR FRONT OF BUILDING { P!'RMIL Nl1MPF.H CITY OF CUPERTINOb65 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 11000 WOLFS ROAD UNIT# LOT# PERMIT EXPIRES IF WORK OWNER HEWLETT PACKARD RFI MESd frNG CUPRRTTND FT,FCTRTC IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. LIFER PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING lel/ tel/ ELECTRICAL ISSUANCE DATE MECHANICAL /Z/E7 T ASL/1/� NLDG. ELECT. PLG. MO. ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR �� ,% (INFORMATION PLUMBING ,UV4 ALUATION SIFT. � � '!! MECHANICAL C>�� PERMIT TO ELECTRICAL FRAMING $TORIES TYPE CONSTR. INSULATION OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF $O.FL FLOOR ANSA LOTAL ACREAGE DIAPHRAGM 9UI LOI USE HES INP CON PR Olney APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ -ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT N0, PARCEL NO. GAS TEST MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG.SITE NO. INSULATION PLUMBING GAS FIRE SPRINK ENERGY T-74 MECHANICAL Y ❑ N❑ v ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOODZONE A.L.u.c. LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT. Y❑ IN ED] YC] No SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING /'`3 BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS' FIREWALLS ELECTRIC PLAN CHECK F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC uJ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. I Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY x BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER BrILONG -� �t�✓fr- APPLICATION & PERMIT ADDREss ILDING-ELECTRICAL-PLUMBING-MECHANICAL 12665 OWNER'$ PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE GAMERACpTGpR$� �+ UTLETS-SWITCHES-RECEP 10.00/1.00 I PLS 1 /do 'LI-,LIC NO LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ADDRESSPPLIANCES-RESIDENTIAL 4.00 ADDRESS (� / [� �j ! ,r�q�lf ' 6- Luce t-rtJ PHONE q/-1900 PANELS 10.00 DATE OF APPLICATION OR PANELS PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE D.C.NO. ENGINEER LIC.No. SIGNS TRANS. 3.00 ADDRRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION zlv TEMP.METER OR POLE INS. 20,00 APPLICANT'S MOTORS ADDRESS SEE FEE SCH. SERVICE CHANGE 20.00 w O O LICENSED CONTRACTORS DECLARATION U I hereby alhrm that I out licensed under provisions of Chapter -,,, ISSUANCE GATE y<a- (commencing with Section 7000)of Division 3 of the Business and (.Y I e O BLOC. ELECT. PLG. MECH, F D z Professions Code, pd m linos¢is in full force u h pf et. '1 z zo m o Licens . s Lie.Number.j_7 Y ~ ` o� 9 y H w Datc - z Contin etor ✓1 .JO O`C rt m¢a OWNER-BUILDER DECLARATION G�-EC Cly BUILDING PERMIT INFORMATION u,v w0 LL v I hereby affirm that I am exempt form the Contractor's License MISC.- REFER TO ORD u o a, Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 /,9.00VALUATION $/FT. V, � � Code:Any city or county which requires a permit to construct,alter, Qw a,Q 2 Improve,demolish,or repair any strucluie,prior to Its Issuance,also ELEC.CONTE. LIC.NO. ELEC. a wO u requires the applicant for such permit to file a signed statement that N TOT, . 00 PERMIT TO se he is licensed pursuant to the provisions of the Contractor's License H z i Law(Chapter 9(cummenciagwith Section 7000)of Division 3 of the ar Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE O the basis for the alleged exemption.Any violation of8ection 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant o a civil Penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars IS500).7: ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work.and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:*The Contractor's License Law does not apply to an owner of . property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SG,FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarcnotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or impmvemcut is sold within one year of completion,the owner- GAS EASYSTEM OVER 4(EA.) 200 BUILDING builder will have the burden of proving that he did not USE build or im- - . - . . EES IND CNG NG PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS FARCE L NO. and Professions Code:*The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with it contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. CiI am exempt under See.-,114P.C.for this WATER HEATER WIVENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACO.FILE NO. WORKS RS'COM PFNSATION DECLARATION WATER TREATING EQUIP, 5.00 1 hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a srlified copy therm (Sec.3800,Lab.C.k Policy No. ComPany�..!- 0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T$4 Z Z `p Ccrtifi�%�[_ with Lc r inspection division. MISC.- REFER TO ORD. � E O Applicant Y N Y N CC m CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U,C. L �_ COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. CL O thi ( s section need not be completed if the permit is for one TOTAL Y❑ N[] Y ❑ NC] DZ hundred dollars IS 100)or less.) U O I certify that in the performance of the work for which this Per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY Il-. I- mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. O Ud Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING >_ W NOTICE TO APPLICANT: IL after making this Certificate of Ex - F Z eruption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK provisions rl' the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency 1'o, EXHAUST HOOD(WITH DUCT) 5.00 the performance3097. aof the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and stale laws relating to building construction, and BOILER-COMM H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX 'n any way accrue,against said Cit cmtse ue e of the PERMIT ISSUANCE 10.00 rami g of this permit. MEC CONT. LIC.NO. MECH. C Q �� TOTAL TOTAL Applicant/Crn[mctor IJate OFFICE COPY